Cocktails of antibiotics aimed at thwarting lethal superbugs may help Venus Remedies Ltd. (VNR) expand at the fastest pace in three years as the Indian drugmaker taps demand from doctors for more bacteria-fighting options.
Venus, which supplies medicines to the world's largest generic drugmaker, Teva Pharmaceutical Industries Ltd. (TEVA), forecasts sales will expand 15 percent for the next two years, driven largely by its treatment for drug-resistant infections of the urinary tract and respiratory system, Chairman Pawan Chaudhary said in an interview.
Sales of fused antibiotics expanded at four times the pace of single-ingredient substitutes in the past two years as physicians in India increasingly relied on cocktails to treat patients with multi-drug resistant infections. Mutant germs producing an antibiotic-destroying enzyme called ESBL first showed up in 1983 and are now responsible for 40 to 80 percent of hospital-acquired infections, according to several studies.
"Resistance has already become a very big problem and in the next five years it's going to be an epidemic," Chaudhary said from his office near Chandigarh in northern India. "We want to give doctors an option, they don't have to rely on the strongest antibiotic to deal with ESBLs."
Sales growth at Venus, set up in 1989, has slowed for six straight years because of declining prices of medicines sold to governments. The company's shares fell 0.2 percent to 279.45 rupees in Mumbai. The stock has risen 83 percent this year, compared with a 29 percent gain on the 17-company BSE India Healthcare Index. (BSETHC)
Bacterial Enzyme
It's become a common practice for drugmakers to introduce a variety of cocktails as there are almost no new antibiotics coming in, Siddhant Khandekar, an analyst at ICICI Direct, said in an interview. Sales of combination drugs containing three of the most commonly used antibiotics have grown 52 percent in the last two years, according to data from IMS Health Inc.
Competition is also intensifying in the market that's led by the Indian unit of GlaxoSmithKline Plc. (GSK)
Augmentin, the best-selling brand in the country, is one such combination of the antibiotic amoxycillin and clavulinic acid, which blocks the activity of a defensive bacterial enzyme. Glaxo is the leader with a 27 percent market share and there are 293 other registered brands for the same product, according to the All India Organization of Chemists and Druggists.
Venus, which also makes injectable medicines to treat pneumonia and meningitis, plans incremental changes and additions to improve the efficacy of existing drugs in ways that can be patented to beat the competition, Chaudhary said.
Sulbactomax Brand
The company's flagship product contains three ingredients: the antibiotic ceftriaxone, a chemical that aids the drug's activity by attacking a defensive enzyme produced by the bacteria, and a compound called EDTA. The compounds have been in use for about three decades and Venus' patents pertain to the specific concentration of the three.
The product is sold under the Sulbactomax brand in seven countries, including Ukraine and Syria, and will be introduced in India next year, Chaudhary said.
In a drug cocktail, three or four ingredients are combined in a single pill or injectable vial. The widespread use of such treatments can also lead to resistance, according to Pankaj Vohra, a pediatric gastroenterologist in New Delhi's Max Hospital.
Bacteria evolve the ability to thwart a drug when it's used repeatedly and this characteristic can be carried in the genes and passed on to other bacteria.
'Indiscriminate' Usage
There is a "strong threat" to the society because patients are demanding quick cures and doctors often prescribe antibiotics without carrying out diagnostic tests, Bhagwat Dhingra, chief executive officer of Unichem Laboratories Ltd. (UL)'s Indian business, said in an interview.
In 2008, researchers studying the case of a diabetic stroke patient of Indian origin found that bacteria cultured from his urine and feces evaded more than a dozen drugs, including last- resort medicines called carbapenems.
The bacteria carried a gene, later named New Delhi metallo- beta-lactamase-1 or NDM-1, that scientists warn is spreading faster, further and in more alarming ways than any they've encountered.
Venus is carrying out laboratory-based tests to verify whether Sulbactomax can work against NDM-1 and will publish the results soon, Manu Chaudhary, head of research, said in an interview.
It's unlikely that the drug would work on NDM-1, said David Livermore, who formerly headed antibiotic resistance monitoring at the U.K.'s Health Protection Agency in London.
The company, which gets about 4 percent of its revenue from selling to Israel's Teva (TEVA), has obtained a patent for Sulbactomax in 40 countries and plans to start sales in 20 nations by 2014.
Demand to treat superbugs such as ESBL has helped sell Sulbactomax, which accounts for about 10 percent of Venus' sales, Chairman Chaudhary said. The company is looking for partners to expand in Africa and South America, he said.
"There is demand because more than anything else, it is giving better results," Chaudhary said. "This is our fastest growing drug."
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